title: Video-assisted thoracic surgery for pulmonary aspergilloma: a safe and effective procedure.
abstract: BACKGROUND
  A variety of complications occur in patients with pulmonary aspergilloma. The safety and feasibility of a thoracoscopic approach to therapeutic lung resection for pulmonary aspergilloma have not been well evaluated.
  
  
  METHODS
  The medical records of patients who underwent video-assisted thoracic surgery (VATS) or a thoracotomy for therapeutic resection of pulmonary aspergilloma between January 2005 and December 2012 were retrospectively reviewed for age, sex, indications for surgery, approach and procedures, postoperative pain, operative time, blood loss, hospital stay, cost, and complications.
  
  
  RESULTS
  A total of 310 patients underwent thoracotomy, 76 patients underwent attempted VATS lobectomy. Seventy-six patients from 310 patients for thoracotomy were selected and compared with the VATS group. Nine cases (11.8%) in the VATS group were converted to a thoracotomy for the following reasons: bleeding (n =2); dense fibrous adhesions (n =3); fused interlobar fissure (n =2); and hilar lymphadenopathy (n = 2). Lesions treated with pneumonectomy failed to be done using VATS. There was no difference in the blood loss and median operative time between the 2 groups, but the patients with VATS had shorter length of stay in the hospital (p = 0.035) and fewer complications (p = 0.032) than those with thoracotomy.
  
  
  CONCLUSIONS
  Video-assisted thoracic surgery is an alternative to open procedures in the management of pulmonary aspergilloma. Simple aspergilloma and complex aspergilloma without infiltration of the hilum are good candidates for VATS resection. Aspergilloma lesions that require a pneumonectomy are still a major challenge for VATS.
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Qian-Kun
authors.initials: QK
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China. Electronic address: jgnwp@aliyun.com.
authors.forename: Ge-Ning
authors.initials: GN
authors.lastname: Jiang
mesh_terms: D000328:Adult; D002681:China; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011013:Pneumonectomy / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D055732:Pulmonary Aspergillosis / Q000175:diagnosis* / Q000601:surgery*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: 11